(Please print, sign and submit this form to your bank, not to Democratiya)

Standing Order Instruction

To:  The Manager
Bank name: ________________________________
Bank address: ________________________________
________________________________
Post code: _______________
Sort code: ____-____-____
Please pay HSBC, 64 Highgate, Kendal, Cumbria, LA9 4TF
for the credit of Democratiya
account no. 01450972
sort code  40-26-02
the sum of £_______________   monthly
starting on ____/____/____   until further notice.
 
Account to debit: ________________________________
Account number: ________________________________
 

 

Signature: ________________________________
Date: ____/____/____